Sunday, January 02, 2011

Please write to your MP

I will be talking about childbirth. It will not be a nice story.

If you've been reading the papers, you'll know that a national scandal is finally coming to light. The government promised three thousand new midwives to the NHS before the election, but have they done anything about it? Of course not; that would mean spending money. The reason they promised the midwives is that birth rates are high, midwife rates are low, and you cannot manage a birth with too few midwives. Women are in labour are being turned away from hospitals that cannot accommodate them. 22% of women in labour are left unattended - more than one in five. The papers acknowledge that this is a 'frightening' experience.

Speaking as one of those one in five, let me state that this is a grotesque understatement. I gave birth over four months ago, and here's what happened to me:

At 43 and a half weeks overdue, I went to the hospital to meet with a consultant for advice. That 'advice' turned out to be the information that if I didn't want to double my son's chances of brain damage, I'd let her book me in for an induction - and when I agreed, the information that the induction would take place the day after tomorrow.

I went into hospital. The first thing the midwife told me was that she was looking after ten women that day. She strapped me to a monitor to check the baby was doing okay before beginning the induction, and left. My husband had to go find her when it seemed the monitor wasn't working - which it wasn't. The allotted half hour passed, and my husband had to go find her again. She gave me a Prostaglandin pessary (the first stage in inductions) and disappeared again. After an hour or so it fell out and my husband once again had to go track her down to get another one.

Visiting hours ended at ten o'clock. At nine o'clock my husband had to go get her so we could insist on some kind of check, because by that time I'd been in pain all afternoon and all evening. Constant pain, not contractions, because that's often the effect of an induction. I didn't know this could happen, though, because she didn't have the time to brief me.

She monitored me for a while, didn't manage to get the time to examine how dilated I was, and disappeared again. At that point my husband was sent home and told visiting hours started again at eight o'clock in the morning.

The night staff was one main midwife and one woman on the desk - a bullying individual who snapped at anyone who asked her for help.

At this point, let me say that the daytime midwife seemed like a perfectly nice person. After the baby was born she came to congratulate me and coo at him. But do you know what happened because of time pressures on this perfectly nice person? She forgot to brief me about pain relief.

Then she went home, leaving me in the care of a skeleton crew with ten women to look after.

The staff shortages meant that my overnight care plan boiled down to this: isolate the woman without pain relief or information for ten hours. No one so much as put a head around the door to see if I was alive or dead. I had to drag out into the corridor in agony to beg for pain relief - which was, it turned out, available if only you knew to ask for it - and wait a long time before it arrived.

At four in the morning, I threw up from the pain. Pressing a call button for help, I was briefly attended by a midwife who examined me and said I was three centimetres dilated and could go up to a labour ward - which meant I could call my husband and community midwives to come keep me company. She said she'd call the labour ward and let them know. Then she disappeared, and I never saw her again. My husband wasn't there to look for her, and I couldn't do it, so she just vanished out of my life for ever.

That was the night shift.

Come the morning, the first midwife returned and tried to get me into a labour ward. Day shift began at eight o'clock. It was noon before I got into one. At that point I was requesting an epidural, so they called for an anaesthetist to come. While waiting, they suggested breaking my waters by hand so as to move the labour along.

'Is it going to hurt?' I said. 'I've been in pain for twenty-four hours, I can't take any more. Maybe we should wait for the epidural.'

'No,' they said, 'it's not painful.'

So they went ahead. They saved themselves a couple of hours in so doing, which probably cleared the room for another patient sooner. They also fucking lied to me. Breaking a membrane doesn't hurt, but what that rush of hormones does to an unprepared cervix is agonising. Between twelve and two I was in constant, relentless pain, because they decided not to wait for the anaesthetist even though I'd specifically said I wanted to if it was going to cause more pain.

So let me sum up. Understaffing meant that I was isolated while in labour for a full night shift, left there by staff who were so rushed they forgot to brief me on pain relief. Or to offer me pethidine, which I've since been informed by the hospital was what they should have done. Or to give me any kind of explanation about what was happening to my body and that of my baby, who, they had recently informed me, was at increased risk of brain damage if he didn't come out extremely soon. It then meant that they lied to me about how painful a procedure would be so as not to slow down the conveyor belt I was on.

This was not an unusual experience. A friend of mine from antenatal class tells me that the day after she gave birth, they had women giving birth on the public antenatal wards because there was nowhere else to put them.

I am trying not to cry as I type this. I can tell you here and now that while I had planned to have another child, now I am seriously questioning whether I can go through that again. I feel sick and terrified every time I enter that hospital - even when I was just returning some property. Heaven help me if I ever need medical treatment there again.

In short: the levels of understaffing and limited accommodations are at crisis point. The NHS needs more money. A lot more money. Something has to give, and if it's not the government's purse strings it'll be women. I'm going to be blunt about this: unless the government fucking pays out like it said it would, they are making the plain statement that they think preserving the pockets of the wealthy is important enough to justify the torture of thousands of women.

The government made a promise. Even if they keep it, it'll only go partway to solving the problem, but they made a promise and they're not keeping it. Please write to your MP and ask them to put on the pressure.

I mean, I knew it was bad, I'm shocked all over again each time you mention what happened to you, but I can't get over that bit about leaving a laboring woman totally alone for ten hours...It'd be bad enough for a natural labor, but for an induction? There are no words.

Except, I'm sorry.

It won't do any good for me to write to your MP, but I hope you and all the rest of the 22% -- not to mention everyone else who cares about the health of mothers and babies-- continue to scream the place down until your government gets its act together.

It's a word I learned watching the extra features on the DVD box set of Rome rather than at college, admittedly, but the notes were put in by a proper academic, so there you go. This is the story:

In ancient Rome prior to the emperors, honestiores - people of status and property - were supposed to be exempt from torture, and it was generally agreed that torturing a noble was cruel. The humbler classes, on the other hand - the humiliores - could be tortured, beaten, crucified and subjected to great maltreatment (slaves' testimony was not considered admissible unless extracted under torture, for instance), and physical cruelty was a fairly normal part of their experience. This was not considered a particularly serious matter.

That, I think, is where we get the word 'humiliate'.

It's in the bones of our language: the idea that suffering is a terrible thing to inflict on people that matter, but not such a problem with lesser folk. It's profoundly humiliating to be treated as if it doesn't matter when you suffer, and our language and history show you why: it's treating you as a person of no worth.

People who think the pain of childbirth isn't a serious business? These are people who either think that all women are humiliores, or that women unfortunate enough to have difficult labours are humiliores while the women who can manage drug-free births - which is to say, the women who don't experience pain that's unbearable - are honestiores. Sexism or Just World Fallacy, or possibly both, but people that bad things should happen to either way.

I'm not in the UK, so I can't write to any relevant MP, but I'm wondering if there isn't room in this for a class action lawsuit. It seems millions of women are being materially harmed (in lots of unnecessary pain, but also ignoring women means if a maiming or life-threatening situation develops, no one is there to fix it). I don't suggest you have the time or energy to do this, but you might see if anyone else is doing it and add your voice to the chorus.

Well, the NHS does get sued if it actually screws up a birth in such a way as to damage the baby. My dad's a medical negligence lawyer, and a big proportion of his cases are incidents of the kind. (Not a comforting set of cases to reflect on while in labour, let me tell you.)

But suing for emotional distress isn't really a UK thing. Among other things, the whole problem is that the NHS is under-funded. Suing it, should the case succeed, would only make it poorer than ever, and it'd be patients like me who'd suffer for it.

You and me both, mmy. In the U.S. one can sue, not for damages, but to get the organization to change its behavior. If that were possible in a case like this, it seems that Kit's father would know about it.

How awful! I had an induced delivery with both of my children, and I can't imagine how dreadful it would be to do that alone. :(

I'm a doctor and my husband is a doctor and we had a midwife with us every single minute, as well as my mother. And it was still hard, and it went for hours and hours.

I cannot imagine how frightening your experience must have been - those of us who work in hospitals sometimes forget how strange they are to those are not there every day.

I now see why so many UK doctors come here to Australia to work! And so many stay!

(But I will just say that the second time around it was totally different. I was induced again, but my body knew what to do, it was quicker it was easier and it was altogether a better experience, despite having a 50% larger baby the second time around! All the best with your family.)

I'm curious as to WHY they're so reticent to use money that's been entrusted to them specifically for such purposes. Money has no way to be its own purpose, after all. In the end, it's just a form of indirect barter.

{sigh} Where's their sense of fealty to the general populace?

On a side note, I also have to wonder HOW freely given testimony from a slave could be regarded as invalid. Then again, if Terry Jones's Barbarians is anything to go by, I get the feeling many of the Romans would have regarded "rule of fear" as a redundant term...

Kit, having seen references to your experiences on Slacktivist I knew it had been bad but had no idea how bad. This is horrific. I'm so sorry that you went through that experience. :(

I know I'm coming very late to this, but there's a relevant aspect that I happen to know a bit about - what happens to people who want to train as midwives in the UK. Which is, mostly, that they can't. One of my sisters - an intelligent, hard-working and all round strong woman - tried desperately to get a place to study midwifery. It wasn't possible - despite the desperate shortage of midwives, university places to study midwifery were actually being reduced, and the law had just been changed to make a degree compulsory. That was two years ago now. Further back, a family friend who moved to the UK from Africa - a fully qualified midwife - attempted to get permission to practice in the UK and came up against so much restrictive red tape that she was forced to take a different nursing position to support herself and her son.So the problem isn't just in the NHS itself - it's also in the universities, and the immigration paperwork, and probably elsewhere across the board. All the people who hear about a midwifery crisis and dismiss it as less important than issues A through to Z, and not worth their time or effort to get new midwives trained/certified.I'll definitely write to my MP on the back of this post of yours (though as my MP is Vince Cable I'm not sure what that's going to achieve!)

Best wishes for your recovery, and for all good things for the small offspring.